CAJ | 학술논문

目的总结治疗重度半侧颜面萎缩症的手术方法.方法 2004年1月至2012年5月,对25例重度半侧颜面萎缩的患者,综合应用自体脂肪游离移植、股前外侧筋膜脂肪瓣、自体真皮游离移植等方法进行软组织重建,应用下颌骨延长技术、正颌技术、自体组织移植或假体植入等方法进行骨骼轮廓重建.结果 25例患者中有24例接受了颧骨增高术和面部脂肪注射；17例接受了正颌手术:Le Fort Ⅰ型截骨3例,颏部截骨整形4例,下颌骨延长配合二期Le Fort Ⅰ型截骨3例,颏部截骨整形联合下颌骨Medpor贴附整形7例；股前外侧筋膜脂肪瓣10例；背阔肌肌瓣修复1例.术后随访6个月至5年,25例患者通过骨骼轮廓和软组织结构重建,倾斜的咬合平面和错颌畸形获得纠正,面部不对称和扭曲畸形得到明显改善.结论对于重度半侧颜面萎缩患者,只有综合应用各种治疗手段进行软组织和骨骼轮廓重建,才能获得良好的治疗效果.
목적 총결치료중도반측안면위축증적수술방법.방법 2004년1월지2012년5월,대25례중도반측안면위축적환자,종합응용자체지방유리이식、고전외측근막지방판、자체진피유리이식등방법진행연조직중건,응용하합골연장기술、정합기술、자체조직이식혹가체식입등방법진행골격륜곽중건.결과 25례환자중유24례접수료권골증고술화면부지방주사；17례접수료정합수술:Le Fort Ⅰ형절골3례,해부절골정형4례,하합골연장배합이기Le Fort Ⅰ형절골3례,해부절골정형연합하합골Medpor첩부정형7례；고전외측근막지방판10례；배활기기판수복1례.술후수방6개월지5년,25례환자통과골격륜곽화연조직결구중건,경사적교합평면화착합기형획득규정,면부불대칭화뉴곡기형득도명현개선.결론 대우중도반측안면위축환자,지유종합응용각충치료수단진행연조직화골격륜곽중건,재능획득량호적치료효과.
Objective To sum up the various procedures for skeleton and soft tissue contour reconstruction in severe progressive hemifacial atrophy.Methods From Jan 2004 to May 2012,25 patients with severe progressive hemifacial atrophy underwent the procedures of lipoinjection,microsurgicalflap transplantation,dermis grafting,distraction osteogenesis,orthognathic surgery and so on for both skeleton and soft tissue reconstruction.Results Among them,zygomatic augmentation and lipoinjection were performed in 24 cases,anterolateral thigh adipofascial flap in 10 cases and latissimus dorsi flap in one case,orthognathic surgery in 17 cases,including Le Fort I osetoectomy in 3 cases,genioplasty in 4 cases,mandibular distraction osteogenesis combined with secondary Le Fort I osteotomy in 3 cases,genioplasty combined with mandibular augmentation with Medpor implant in 7 cases.The patients were followed up for 6 months to 5 years.Through skelton and soft tissue reconstruction,the oblique occlusion plane and malocclusion were corrected with great improvement in face asymmetry.Conclusions For severe progreassive hemifacial atrophy,comprehensive procedures should be adopted for both skelton and soft tissue reconstruction to achieve good results.